Trauma and stressor related disorders

1. Trauma and
Stressor- Related
Disorders
Psychosocial 650

2. Trauma and Stressor-related
Disorders (TSDs)
• Stress and trauma have a pervasive impact on
individuals and communities across the lifespan
• Broad array of adverse experiences that result
in psychological, neurophysiological, and
medical complications, specifically when left
untreated

3. Trauma vs Stress
• Trauma: Refers to an event
• Stress: Response to an event

4. Trauma
• “A single event, multiple events, or a set of circumstances that is
experienced by an individual as physically and emotionally harmful or
threatening and has lasting adverse effects on the individual”
(SAMSHA, 2014).
• Effects of trauma can impact the individual’s physical, social,
emotional, and/or spiritual well-being
• Natural or human causes, intentional or unintentional

5. Signs and Symptoms of Trauma
Cognitive
• Memory problems
• Confusion
• Change in level of alertness
• Poor attention and
concentration
• Difficulty with problem-solving
and decision-making skills
Emotional
• Agitation
• Irritability
• Grief
• Guilt
• Fear
• Anxiety
• Anger

6. Signs and Symptoms of Trauma
Physiological
• Difficulty with breathing
• Fatigue
• Pain
• Headaches
• Difficulty maintain BP and HR
• Nausea
• Muscle Twitching
Behavioral
• Emotional outbursts
• Social withdrawal
• Difficulty sleeping
• Change in communication
• Anti-social acts
• Increased alcohol/substance use
• Self-injurious behaviors
• Changes in appetite/eating

7. Polytrauma
• Repeated trauma
• Typically includes injury to body parts and organs
• Polytrauma often co-occurs with other types of
overwhelming traumatic experiences

8. Effects of Trauma
• Temporary or Long-Term
• Mild, Moderate, or Severe
• May lead to greater mental health problems
• Post-Traumatic Stress Disorder, Mood disorders,
Substance Use Disorders, Medical disorders
(chronic pain, cardiovascular disorders), behavioral
issues, problems with occupational participation

9. Stress
• State of tension causing anxiety or worry
(Merriam-Webster, 2016)
• Natural response to a stressor
• Highly variable based on individuals
• Moderate or severe stress impacts the
individual’s ability to participate in occupations
and to cope

10. Acute and Chronic Stress
• Acute Stress
• Stress response elicited from a highly stressful or traumatic event
• Symptoms are short-lived
• Chronic Stress
• Repeated and prolonged activation of the stress response
• Impacts mood, memory, attention span, focus, functioning, ability to
participate in life roles
• Lifestyle changes to cope: smoking, over-eating, over-using alcohol/drugs

11. Traumatic Stress
• Form of stress that may happen when an
individual experiences traumatic situations or
events that impact the person’s ability to cope
and participate in occupations

12. Evidence-Based Practice
• Recent Study:
• Effects of chronic stress overwhelms the
nervous system
• Leads to chronic inflammation (one of the main
causes of chronic and degenerative diseases)

13. Adjustment Disorder (DSM-5)
• Occurs when an individual experiences stressors that
trigger a cascade of emotional responses and a host of
corresponding occupational difficulties (APA, 2013)
• The degree of distress caused from stressors is clinically
significant and negatively impacts the patient’s ability
to function
• Increased risk for suicidal ideation, suicide attempts,
and acts of suicide

14. Adjustment Disorder (DSM-5)
• Onset is within 3 months of experiencing the stressor
• Symptoms do not last longer than 6 months
• Cause: Stress which can be a single event, an event that
has wide-reaching effects, or multiple-events or an
ongoing situation.

15. Occupational Therapy and
Adjustment Disorder
• Collaborate with individuals
• To identify, develop, and utilize the patient’s
protective factors for prevention and treatment
• Provide a client-centered and resilience-focused
approach
• Help them overcome the influence of stress and
trauma

16. Occupational Therapy and
Adjustment Disorder
• Guide clients to explore
• Coping modalities
• Occupations that support health, well-being,
quality of life

17. How Adjustment Disorder impacts
Occupational Performance
• Difficult to complete tasks and meet demands (work,
school, home, routines, activities)
• OT:
• Help identify factors impacting their ability to function
• Guidance to engage in meaningful roles, routines, and
occupations
• Support for health, wellness, and recovery

18. Adjustment Disorder and OT
Interventions
• Psychoeducation
• Increase knowledge on condition
• Identify and develop coping strategies (stress
management, sensory tools)
• Support and assistance to foster engagement in
occupations (self-care, leisure, sleep)

19. Posttraumatic Stress Disorder
(PTSD)
•May occur after having a traumatic experience or witnessing a
traumatic event
•Onset of symptoms: within 3 months after trauma
•4 symptom clusters
•Intrusion
•Persistent avoidance
•Persistent negative thoughts and feelings
•Marked alterations in arousal and reactivity
•Acute Stress Disorder

20. Terms related to PTSD
• Dissociation
• Wide range of occurrences during which one experiences
an altered state of consciousness (APA, 2013)
• Range from daydreaming, feeling less present in one’s
body, lack of sense of self/identity
• Symptoms: depersonalization (difficulty feeling bodily
aware) or derealization (difficulty with feeling oriented to
one’s surroundings)

21. Terms related to PTSD
• Trigger
• A Stimuli that reminds an individual of a stressful or
traumatic experience
• Stimuli: person, place, thing, activity, context
• Examples: scents, sudden/loud sounds, feelings of
immobility, individual with a similar voice, stature, etc.
to the perpetrator of the traumatic experience, a place
that in some way resembles the site of the event

22. Symptom Cluster: Intrusion
• Intrusion
• Re-experiencing of a traumatic memory
• Involuntary, distressing, and reoccurring recollections of the
traumatic event(s), may be with or without triggers
• Recollections may have neurophysiological, sensory, emotional,
and behavioral qualities
• Flashbacks, distressing dreams and nightmares
• Flashbacks-type of dissociative experience, where the
individual feels the event is happening in the current

23. Symptom Cluster: Persistent
Avoidant
• Persistent Avoidant Behaviors: triggers may lead to
unpleasant or distressing feelings and individuals may
avoid these experiences if at all possible to decrease
retraumatization
• Having to talk about, see objects/people, engage in
activities that may arouse traumatic responses can be
overwhelming and triggering

24. Symptom Cluster: Persistent
Negative Thoughts and Feelings
• Changes in thought patterns or emotional states as a
direct result of having experienced trauma
• Example: Difficulty remembering the details of a trauma-
related event
• Persistent feelings of negative self-worth, shame and
guilt, altered sense of identity
• Persistent difficulty with mood and feeling a lack of
interest in engagement in activities and occupations

25. Symptom Cluster: Marked
alterations in arousal and reactivity
• A significant or marked alteration in arousal and reactivity because of a
traumatic experience
• Arousal: the neurophysiological stress response, influences emotions,
thoughts, feeling, and behaviors
• Autonomic arousal may lead to
• Overreactive startle response(jumpy), difficulty with attention,
concentration, memory, or sleep, engagement in self-injurious
behaviors (self-mutilation, drug/alcohol use), reckless behavior,
• Reactivity as a result of change in arousal
• Aggression, irritability, anxiety, angry outbursts

26. PTSD
• Highest risk: individuals who have been raped, experienced military
captivity or combat, or experienced political or ethnically motivated
imprisonment or genocide
• Increased risk: having a vocation that involves emergency or
traumatic situations (police, firefighters)
• Recurrence of symptoms
• Reminder of the traumatic event
• Significant life stressors (divorce)
• Risk of self-injury, suicidal ideation, engagement in suicidal attempts

27. PTSD and how it impacts occupational performance
• Cognitive symptoms
• Difficulty staying focused and on task
• Easily distracted
• Safety concerns (not being fully aware when driving,
cooking)
• Impeded ability to complete daily activities (self-care, sleep
and rest, work, school responsibilities)

28. PTSD and how it impacts
occupational performance
• Social and emotional symptoms
• Anxiety, fear, and panic; impede ability to bond,
socialize and complete daily routines and activities
• Social situations may be difficult to control and can be
overwhelming
• May lead to avoidance of relationships

29. PTSD and how it impacts
occupational performance
• Physiological Symptoms
• Increased autonomic nervous system arousal,
heightened hypersensitivity
• Impacts ability to rest/sleep, performance in
tasks at school, work, and home ( grocery
shopping, giving a presentation)

30. Other Diagnoses
• Reactive Attachment
• Disinhibited Social Engagement Disorder (DSED)
• Emerge in childhood and are associated with
inadequate caregiving

31. Childhood Attachment
• Typical childhood attachment allows the child to;
• Develop the capacity to bond
• Self-regulate
• Develop higher level capacities
• Child knows that an adult will meet their needs for
love, comfort, and emotion regulation. This provides a
sense of safety and security.

32. Reactive Attachment Disorder
(RAD)
• Internalized disorder
• Persistent emotional and social disturbances (at least 2)
• Limited expression of positive affect
• Minimal emotional and social responsivity to others
• Episodes of unexplained fearfulness, sadness or irritability that are seen
in nonthreatening interactions with caregivers
• Symptoms of depression and social withdrawal
• The child does not seek or respond to comfort when distressed

33. Why do we see these behaviors with
Reactive Attachment Disorder?
• The child had a lack of:
• Basic physical and safety needs
• Comfort and positive emotional bonding experiences
• Developmentally appropriate stimuli and activity
opportunities
• Stability in caregivers
• Opportunities to form selective attachments

34. Disinhibited Social Engagement
Disorder (DSED)
• Externalizing behaviors (may look similar to ADHD)
• Child demonstrates at least two of these
• Decreased or absent restraint or discretion in approaching or
interacting with adults who are familiar
• Overly familiar physical or verbal behavior that is not consistent with
age-appropriate boundaries
• Willingness to go off with an unfamiliar adult
• Lack of or absent checking back in after venturing way from adults

35. Etiology and Prognosis
• Reactive Attachment Disorder and Disinhibited Social Engagement Disorder
• Occur when there was severe abuse, neglect, and/or deprivation by the
primary caregiver in early infancy and childhood
• Pervasive impact on
• Neurodevelopment, socio-emotional skills, cognitive
skills, and language skills
• Interpersonal skills are impacted significantly

36. Trauma-Informed Care
• National and international MH initiative
• Professionals Must:
• 1. Understand the high prevalence of trauma in people
seeking MH services
• 2. Be educated on the pervasive neurophysiological, social,
emotional, and functional influence of trauma
• 3. Provide services that address each clients specific and
individual needs/concerns

37. Key Principles for Trauma-
Informed Care
• SAMSHA identified 6 key principles for Trauma-Informed Care
• 1. Safety
• 2. Trustworthiness and Transparency
• 3. Peer Support
• 4. Collaboration and mutuality
• 5. Empowerment, voice, and choice
• 6. Cultural, historical, and gender issue competence (or sensitivity)

38. Medication
• Medication may improve the symptoms of depression, anxiety,
and psychotic symptoms related to PTSD
• Deficiency in serotonin is sometimes evident in people with
PTSD
• Antidepressants
• Antianxiety medications
• Atypical antipsychotic agents

39. OT’s Role with Medication
• Help clients
• Be aware of, track, and report potential
benefits of concerns that may be medication-
related

40. OT Interventions (for all Trauma
and Stressor-related Disorders)
• Self-Esteem Development
• Developing a positive sense of self
• Recognizing and reinforcing strengths
• Therapeutic Writing and other creative media
• Helps with personal understanding and coming to terms with
trauma
• Use of writing or other creative media (Painting, Dancing,
Music) to tell stories related to trauma

41. OT Interventions (continued) (for all
Trauma and Stressor-related Disorders)
• Sensory Rooms
• Identifying and addressing sensory modulation needs and
goals
• Room with calming sensory input, patient can use the room
when feeling agitated, angry, or anxious
• Combat and Operational Stress Control Units
• Managing stress to keep service members in the unit
• Develop coping mechanisms, enhancing self-care, managing
stressors while participating in military duties and routines

42. OT Interventions (continued) (for all
Trauma and Stressor-related Disorders)
• Cognitive Behavior Approach (distorted beliefs)
• Dialectical Behavior Therapy (emotion regulation)
• Trauma-Informed Care (honoring a person’s trauma history and
promoting safety)
• Mindfulness Meditation (emotional well-being)
• ADL and IADL Skill Training (behavioral strategies to promote
acquisition of new skills)
• Dunn Model of Sensory Processing (sensory needs in the context of
occupational performance, create environments/materials that meet
the sensory processing needs)

43. OT’s Role
• Supportive and nurturing interventions have a
healing influence on individuals

44. The Lived Experience: JoDee
• What occupations are important to JoDee?
• What personal and environmental factors contributed
to her recovery process?
• Which factors interfered with her recovery process?
• What might have made her recovery process easier?
• What are some examples where Trauma-Informed Care
was NOT utilized?

45. Learning Activity
• Imagine a home, school, or leisure situation
in which you feel incompetent, afraid,
and/or unwanted as an adult
• Name 5 examples of strategies you could
use in that situation to foster your ability to
participate in these areas of occupation